Tüm alıştırma soruları

An otherwise healthy 62-year-old male is evaluated in the emergency department for a 6-hour history of acute, intense, colicky abdominal pain accompanied by several episodes of bilious vomiting. His past medical history is notable only for an open appendectomy performed 15 years ago for a ruptured appendix. On current evaluation, his temperature is 37.1°C (98.8°F), blood pressure is 135/85 mm Hg, pulse is 92/min, and respiratory rate is 16/min. The abdominal examination is significant for pronounced distention and high-pitched, hyperactive bowel sounds. Palpation elicits moderate, diffuse tenderness, though there is no evidence of guarding, rigidity, or rebound tenderness. Initial laboratory investigations reveal a leukocyte count of 9,500/mm³ and a serum lactate concentration of 1.1 mmol/L (Normal: 0.5 - 1.5 mmol/L). An abdominal and pelvic computed tomography scan with intravenous contrast reveals a distinct transition point in the distal jejunum with substantial upstream small bowel dilation. Additionally, a C-shaped, fluid-distended segment of small bowel is noted, and the corresponding mesenteric vasculature is seen tapering toward a central focal point. Which of the following is the most appropriate next step in the management of this patient?

A 42-year-old man presents to the emergency department with a painful, rigid erection that has persisted for 10 hours. He denies any recent sexual activity or use of phosphodiesterase inhibitors, but reports a history of sickle cell trait. Penile blood gas analysis reveals a pO2 of 25 mmHg, pCO2 of 80 mmHg, and pH of 7.15, confirming the diagnosis of ischemic priapism. Non-invasive measures such as systemic analgesia and intravenous hydration have already been initiated.

Arrange the following stepwise interventions in the correct escalating order for managing this patient's condition.

A pharmaceutical company conducts a 3-year, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of a novel medication in preventing the progression to end-stage renal disease (ESRD) in patients with type 2 diabetes and chronic kidney disease. A total of 3,000 patients are enrolled and randomly assigned in a 1:1 ratio to receive either the novel medication or a placebo. All patients complete the 3-year follow-up period. The study results are summarized in the following table:

Based on the information provided, how many patients must be treated with the novel medication for 3 years to prevent one additional case of end-stage renal disease compared to placebo?

A 25-year-old man is brought to the emergency department after a motorcycle collision. Examination reveals an obvious deformity of the right lower leg with a 4-centimeter laceration over the anterior tibia, exposing the underlying fractured bone. Distal pulses are palpable, and the patient has intact sensation in the foot. Arrange the following steps in the most appropriate chronological sequence for the acute management of this patient's open fracture.

Match each patient's clinical presentation and pancreatic cyst fluid analysis with the most accurate diagnosis and corresponding appropriate surgical management strategy.

Match each classic clinical and radiographic presentation with the most likely neurosurgical diagnosis or herniation syndrome.

A clinical study is conducted to evaluate a novel rapid diagnostic test for a specific bacterial infection. The study enrolls $1,000$ participants. A gold standard culture method confirms that $100$ participants currently have the infection. The novel rapid test returns a positive result for $90$ of the infected participants. Additionally, the rapid test returns a positive result for $30$ participants who do not have the infection. All other participants tested negative. What is the positive predictive value of this novel rapid diagnostic test, expressed as a percentage?

A large retrospective cohort study evaluates the association between severe nocturnal continuous positive airway pressure (CPAP) non-adherence and the 5-year incidence of major adverse cardiovascular events (MACE).

Initial analysis reveals a crude relative risk (RR) of 2.8 (95% CI: 2.1 - 3.7) for MACE in CPAP non-adherent patients compared to adherent patients. The investigators perform stratified analyses for Body Mass Index (BMI) and concurrent beta-blocker therapy:

Based on these stratified analyses, which of the following biostatistical approaches are mathematically appropriate for handling these variables in the final analysis? (Select all that apply)

A 62-year-old man is evaluated on postoperative day 2 following a four-vessel coronary artery bypass grafting (CABG) procedure. His temperature is 38.3°C (101.0°F), blood pressure is 128/82 mmHg, pulse is 88/min, and respirations are 16/min. He reports mild chest wall pain at the incision site but denies shortness of breath, cough, dysuria, or leg swelling. Physical examination reveals decreased breath sounds at the lung bases bilaterally without crackles or wheezing. The sternal surgical wound is clean, dry, and intact with no erythema, induration, or discharge. His indwelling urinary catheter was removed on postoperative day 1. Which of the following is the most likely cause of this patient's fever?

A 62-year-old female with a history of hormone receptor-positive breast cancer treated with a mastectomy four years ago visits an outpatient clinic due to progressively worsening mid-back pain over the past three weeks. The pain is localized to the thoracic region and worsens when she coughs or lies flat. Over the last 48 hours, she has noticed increasing heaviness in both legs and had an episode of urinary incontinence earlier today. Her temperature is 37.0°C (98.6°F), blood pressure is 138/86 mmHg, and heart rate is 82/min. Neurologic examination reveals 3/5 muscle strength in the bilateral lower extremities. Deep tendon reflexes are 3+ at the patellae and ankles, and bilateral plantar reflexes are extensor. Pinprick sensation is diminished below the level of the umbilicus. Which of the following is the most appropriate initial step in management?

Match each clinical presentation with the most appropriate next step in surgical management.

A 28-year-old man is evaluated in the intensive care unit. He was involved in a high-speed motor vehicle collision 24 hours ago. His injuries include a severe traumatic brain injury and a closed, comminuted midshaft fracture of the right tibia. He is currently intubated, sedated, and unresponsive to commands. His vital signs include a blood pressure of $105/65\text{ mm Hg}$ and a heart rate of $98/\text{min}$. The nursing staff reports that the patient's right lower leg has become increasingly firm over the past two hours. On physical examination, the right calf is tense, swollen, and non-compressible. The right dorsalis pedis and posterior tibial pulses are easily palpable, and capillary refill in the toes is less than 2 seconds. Which of the following is the most appropriate next step in the management of this patient's extremity?

Pair each patient presentation with the most appropriate initial diagnostic test or immediate management step.

A family physician is evaluating the utility of a rapid antigen detection test for streptococcal pharyngitis in a community clinic. Over the past year, the physician notices that during the summer months, when streptococcal pharyngitis is rare in the community, a positive rapid test frequently turns out to be a false positive upon throat culture confirmation. However, during the winter school months, when the infection is highly prevalent, a positive rapid test is almost always confirmed as a true positive by culture. Assuming the intrinsic diagnostic properties of the rapid test remain constant, which of the following statistical parameters of the test is highest during the winter months compared to the summer months?

A 22-year-old man is brought to the emergency department by emergency medical services after being ejected from a motorcycle at high speed. He was not wearing a helmet. Upon arrival, he does not open his eyes to pain, makes incomprehensible sounds, and exhibits abnormal extension of his upper extremities to painful stimuli. His right pupil is 7 mm and nonreactive to light, while the left is 3 mm and reactive. Blood pressure is 165/95 mmHg, heart rate is 55/min, and respiratory rate is 10/min and irregular.

Arrange the following interventions in the correct chronological order from FIRST to LAST in the acute management of this patient.

Awakened abruptly by excruciating unilateral pelvic and scrotal pain, a $16$-year-old adolescent is brought directly to the emergency department triage desk at $3:00$ AM. He is visibly distressed, pacing the room, and reports vomiting twice since the onset of symptoms $2$ hours ago. The patient has no past medical history and states he is not sexually active. Vital signs reveal a heart rate of $110$/min and blood pressure of $135/85$ mm Hg, and he is afebrile. Genitourinary examination demonstrates an indurated, highly tender left testicle that is positioned abnormally high in the hemiscrotum with a horizontal axis. Stroking the inner aspect of the left thigh elicits no elevation of the ipsilateral testicle, whereas the reflex remains intact on the right side. Which of the following interventions is most urgently indicated?

Match the following specific orthopedic injuries with their most commonly associated neurovascular complication.

A public health physician is investigating an outbreak of acute gastroenteritis following a large community picnic. To determine the source of the outbreak, the physician identifies 50 individuals who developed gastroenteritis symptoms within 48 hours of the event. The physician then identifies 100 individuals who attended the picnic but did not develop any symptoms. Both groups are interviewed about the specific foods they consumed at the picnic. Which of the following best describes the epidemiologic study design used in this investigation?

A 68-year-old male with a 20-year history of poorly controlled type 2 diabetes mellitus and chronic kidney disease presents to the vascular surgery clinic due to progressive, severe pain in his right foot. The pain has been present for four weeks, worsens at night when he is lying in bed, and improves significantly when he sits on the edge of the bed and dangles his legs. Physical examination reveals a cool, pale right foot with a 1-cm, shallow, dry, well-demarcated ulcer on the tip of the great toe. No surrounding erythema, warmth, or purulent exudate is noted. The right femoral pulse is palpable, but the popliteal, dorsalis pedis, and posterior tibial pulses are nonpalpable. A bedside ankle-brachial index (ABI) test is performed. The right ABI is 1.45, and the left ABI is 1.10. Which of the following is the most appropriate next step in the diagnostic evaluation of this patient?

A 32-year-old man is brought to the emergency department after a high-speed motor vehicle collision. He reports severe pain in his hips and lower back. Vital signs show a temperature of 37.0°C (98.6°F), blood pressure of 82/50 mmHg, pulse of 134/min, and respiratory rate of 22/min. Physical examination reveals an ecchymotic and unstable pelvis upon gentle anterior-posterior compression. A focused assessment with sonography for trauma (FAST) is negative for free intra-abdominal fluid, and a chest x-ray is clear. There are no obvious external sources of bleeding. Large-bore intravenous access is established, and aggressive fluid resuscitation is initiated. Which of the following is the most appropriate next step in management?